EmergencyCare Plus® Insurance n PRODUCER Guide
Insurance policies issued by:
American General Life Insurance Company
Coverage for
when you
need it
most...
ACCIDENTAL INJURY
INSURANCE
For agent use only —
Not for dissemination to the public
Table of Contents
Introduction
Policy Highlights....................................................................................................................... 3
The Statistics............................................................................................................................. 4
About EmergencyCare Plus Insurance.................................................................................... 4
Policy Features
Qualifying Events and Covered Conditions (Base Plan)....................................................... 5
Optional Policy Riders......................................................................................................... 6 – 8
Conversion Privileges............................................................................................................... 9
Renewability.............................................................................................................................. 9
Exclusions................................................................................................................................ 10
Benefit Payment Conditions.......................................................................................... 10
Underwriting.................................................................................................................... 11
Family Coverage........................................................................................................ 12 – 13
Premiums................................................................................................................... 14 – 17
Application Process................................................................................................... 18 – 19
Glossary of Terms...................................................................................................... 20 – 22
Important: Prior to soliciting business, be certain that you are appropriately licensed and appointed with the insurer and that the
product has been approved for sale by the insurer in that state. If uncertain, contact your profit center for assistance.
Policy
Highlights
Issue Ages
■■ 18 to 64
■■ Guaranteed renewable
to age 75
Markets
■■ Individual
■■ Worksite (voluntary
payroll deduction,
minimum of
10 applications)
Coverage Options
■■ Individual
■■ Individual and Spouse
■■ Individual & Child(ren)
■■ Family
Coverage Options:
Base Benefits
■■ 24-hour coverage
Simplified
Underwriting
■■ Accept or reject
■■ Based upon application
questions only
■■ No attending physician
statement, parameds
or exams
Riders
■■ Accident-only Disability
Income Benefit Rider
(primary insured only)
■■ Hospital Cash Rider
■■ Accidental Death and
Dismemberment Rider
Did you know that in 2007,
34.3 million people— about
1 out of 9 — sought medical
attention for an injury?1
About
EmergencyCare
Plus Insurance
Even with all the precautions
your clients take to keep
themselves and their families
safe, accidents sometimes
happen and can create
unexpected financial burdens
and inconvenience to daily
life activities. EmergencyCare
Plus insurance from American
General Life Insurance
Company (American General
Life) provides benefits for a
wide range of accident-related
costs with 24-hour coverage.
The policy also covers many
expenses not usually addressed
by traditional health plans, such as
4 INTRODUCTION
the transportation and lodging
costs of treatment at a nonlocal facility. EmergencyCare
Plus insurance is the perfect
complement to your clients’
existing coverage and benefits
are paid directly to them
(regardless of coverage by
your clients’ other sources) to
address their individual needs,
such as:
■■ Child and adult sports injuries
■■ Emergency medical
treatment
■■ Follow-up treatment
■■ Surgery
■■ Accidental death
■■ Transportation for treatment
in another city
More Statistics
■■ About 35% of the
disabling injuries
suffered by Americans
in 2007 occurred
off the job — and
therefore were not
covered by workers’
compensation1
■■ Disabling injuries in
the United States
occur at a rate of about
2,934 an hour1
National Safety Council, Injury
Facts, 2009
1
Benefit payments listed represent one unit of coverage.
Accidental Death
Dismemberment
$25,000 primary
$5,000 spouse
$1,000 child(ren)
Qualifying Events
and Covered
Conditions
(Base Plan)
Up to $15,000 primary (Vermont $25,000)
Up to $7,500 spouse (Vermont $5,000)
Up to $2,500 child(ren) (Vermont $5,000)
■■ Accidental death
Emergency Treatment
$50
■■ Emergency treatment
Accident Follow-up
$15 per treatment, 3 treatments
per accident
Ambulance
$75 via ground
$500 via air
Burns
$2,500 for burns to 30% or more of
the body
■■ Dismemberment
■■ Accident follow-up
■■ Ambulance
■■ Burns
■■ Dislocation
■■ Family lodging
■■ Fracture
$1,000 for burns to 20 – 29% of the body
■■ Lacerations
$500 for burns to 10 – 19% of the body
■■ Diagnostic exams
Dislocation
Up to $1,700 for open reduction
Up to $450 for closed reduction
Family Lodging
$50 per day, 30 days maximum
Fracture
Up to $2,000 for open/compound fracture
■■ Paralysis
■■ Physical therapy
■■ Prosthesis
■■ Surgery
■■ Transportation
Up to $1,000 for closed fracture
Lacerations
$50
Diagnostic Exams
$75
Paralysis
$2,500 quadriplegia
$1,500 hemiplegia
$1,000 paraplegia
Physical Therapy
$10 per treatment, maximum of
10 treatments
Prosthesis
$250
Surgery
Up to $400
Transportation
$150 round trip
POLICY FEATURES 5
Optional Policy Riders
Accident-only Disability Income Benefit Rider
The optional Accident-Only Disability Income Benefit Rider may
provide the insured with a flat monthly benefit if the insured is
unable to work due to injuries sustained in a covered accident.
■■ This rider is only available for the primary insured
■■ The insured must actively work at least 30 hours a week to
qualify for purchase of this rider
■■ The rider will pay up to 60% of earnings at the time of disability
■■ This benefit is not payable for disabilities due to sickness
■■ Coverage is either “off-the-job” or “24-hour” (includes on-thejob and off-the-job accidents)
■■ This coverage does not coordinate with other disability
insurance, workers’ compensation or Social Security benefits
■■ This disability income rider will be an optional coverage on all
levels of accident base coverage
In the event of an accident, where the employee becomes totally
disabled and unable to work (standard definition), the benefit will
pay $100 per month per unit. The minimum number of units is four,
and the maximum number of units is ten. The maximum number
of months for which the benefits covered by this rider are payable
is either six or twelve months. The elimination period is seven days.
This rider includes a premium waiver on the entire premium for the
base policy. However, if this rider terminates, the premium waiver
will also terminate.
■■ The premiums for this rider will be level for the life of the rider
■■ This rider will be available up to age 70
■■ The modal factors are the same as on the EmergencyCare Plus
insurance product
■■ The grace period for this rider is 31 days, and the free look
provision extends for 10 days
■■ There is no age banding associated with this rider
■■ Coverage is available for the primary insured only, but can
be added to any of the four base coverage tiers — Individual;
Individual and Spouse; Parent and Child(ren); Family
■■ A premium will be calculated for an adult, used only for the
primary insured. The premium will be based on occupation class,
which will be determined at the employee level. Occupation
Class 1 will receive preferred rates, and Occupation Class 2 will
receive standard rates. See separate Occupation Class listing for
more information on page 11.
6 OPTIONAL POLICY RIDERS
Optional Policy Riders
(continued)
Hospital Cash Rider
The optional Hospital Cash Rider pays benefits for the primary
insured for hospital admission, hospital confinement, intensive care
and rehabilitation resulting from a covered accident. The maximum
number of units is five. Each benefit has limits on the number of
days of payment per year and lifetime. This is an indemnity benefit.
If the rider is selected, all dependents covered by the base plan will
be covered by the Hospital Cash Rider. See rider premiums in the
“Premiums” section for more information.
Hospital Cash Rider — Benefit Payments
This rider will pay the following benefits per unit of coverage.
Care Category
Benefit Amount
Per Unit of Coverage
1. Hospital Admission Benefit
$350 per admission
2. Hospital Confinement Benefit
$75 per day
3. Intensive Care Unit Benefit
$75 per day
4. Rehabilitation Unit Benefit
$20 per day
Hospital Cash Rider — Benefits Descriptions
1. Hospital Admission Benefit
The company will pay the applicable principal sum upon the
insured’s admission to a hospital as the result of injuries
sustained in a covered accident. This benefit is payable as a lump
sum and is in addition to the Hospital Confinement Benefit. The
confinement must begin within 72 hours after the accident. This
benefit is payable only once per year.
2. Hospital Confinement Benefit
The company will pay the applicable principal sum if the insured is
confined to a hospital for at least 24 hours as the result of injuries
sustained in a covered accident. The confinement in the hospital
must begin within 72 hours after the accident. This benefit is
limited to 30 consecutive days of hospital confinement per injury
for each insured person. The lifetime limit for this benefit is 365
days for each insured person.
3. Intensive Care Unit Benefit
The company will pay the applicable principal sum if the insured
is confined to an intensive care unit of a hospital as the result of
injuries sustained in a covered accident and is only payable on
the same days the Hospital Confinement Benefit is payable. This
benefit is limited to 15 days of intensive care unit confinement
per injury for each insured person.
OPTIONAL POLICY RIDERS 7
Optional Policy Riders
(continued)
4. Rehabilitation Unit Benefit
The company will pay the applicable principal sum if an insured
is confined to a hospital and receiving benefits under the policy
for injuries sustained in a covered accident and is transferred to a
rehabilitation unit of the hospital. This benefit is limited to 30 days
of rehabilitation unit confinement per injury, up to a maximum of
60 days per year, for each insured person.
Note: The company will not pay the Hospital Confinement Benefit
and the Rehabilitation Unit Benefit on the same day. Instead, the
company will pay only the higher eligible benefit.
Accidental Death and Dismemberment Rider
The Accidental Death and Dismemberment Rider gives the insured
the option to purchase additional levels of accidental death coverage.
Benefits can be purchased in units of $25,000 each; there can be a total
of six additional units purchased (if four base units and six rider
units are purchased, the total maximum accidental death and
dismemberment benefit available for the policy is $250,000).
Accidental Death Benefit Payments
This rider will pay the following benefits per unit of coverage.
Accidental Death
Benefit for
Benefit Amount Per Unit of Coverage
$25,000
Insured
12,500
Insured Spouse
2,500
Insured Child
Dismemberment Benefit Payments per Unit
Insured
Insured
Spouse
Insured
Child
$25,000
$12,500
$2,500
Both Hands or Arms
25,000
12,500
2,500
Both Feet or Legs
25,000
12,500
2,500
One Hand or Arm and
One Foot or Leg
25,000
12,500
2,500
One Eye
12,500
6,250
1,250
One Hand or Arm
12,500
6,250
1,250
One Foot or Leg
12,500
6,250
1,250
One or More Entire Toes
1,500
750
150
One or More Entire Fingers
1,500
750
150
For the Loss of:
Both Eyes
8 OPTIONAL POLICY RIDERS
Conversion Privileges
The company will issue a separate accident policy to an insured child
or insured spouse as long as written application with payment of
the first premium is received within 31 days following termination of
the original policy. The conversion privilege will be extended to the
spouse upon the death of the primary insured or the dissolution of
marriage by legal divorce decree and prior to the policy anniversary
on or following the insured spouse’s 64th birthday or the conversion
privilege will be extended to the insured child within 31 days
following the termination of his or her coverage under the policy.
The new policy will be issued:
■■ without evidence of insurability;
■■ on a policy form currently being issued by American General
Life in the insured’s state of residence, provided that accident
coverage can be issued or is still being issued in that state;
■■ with the same exclusion and pre-existing condition limitation
applicable to such insured person, if any, included in the policy;
■■ with a current date of issue;
■■ at the premium rate and class in effect for the insured person’s
attained age and sex on the date of application for the new policy;
■■ with the same benefits payable, if any, reduced by any benefits
previously paid for the same injuries stated by the policy; and
■■ with the same incontestable and “time limit on certain defenses”
provisions commencing on the effective date of the insured
person’s coverage provided by the policy
Conversion Underwriting Requirements: New policies will be issued
without underwriting.
Renewability
Guaranteed renewable on each policy anniversary until the age
limitations specified below.
Primary Insured: Coverage will terminate at the policy anniversary
on or next following the insured’s 75th birthday
pouse: Coverage will terminate at the policy anniversary on or next
S
following spouse’s 75th birthday
Children: Coverage will terminate at the policy anniversary on or
next following the insured child’s 18th birthday or the insured child’s
25th birthday if the child is a full-time student in either secondary
school or an institution of higher learning beyond secondary school.
Coverage will also be terminated for the children’s coverage when
the base insured and the spouse reach their age limitations. The
children will have the option of converting their policy to a currently
issued individual policy without underwriting.
POLICY FEATURES 9
Exclusions
No benefits are payable for or on account of:
■■ Covered services provided that are not related to a covered accident
■■ Any accident or any loss caused in whole or in part by, or resulting
in whole or in part from, the following:
– the insured person’s suicide or attempt at suicide, or intentional
self-inflicted injury or sickness, or any attempt at intentional selfinflicted injury or sickness while sane or insane
Benefit Payment
Conditions
The company will pay the
benefits listed below for
covered occupational and nonoccupational injuries, subject
to the conditions and amounts
stated in the policy.
– the insured person’s being under the influence of an excitant,
depressant, hallucinogen, narcotic; other drug; or intoxicant
including those taken as prescribed by a physician
The payment of benefits for
an accident stated in the policy
schedule is subject to the
following conditions:
– the insured person’s commission of or attempt to commit an
assault or felony
■■ The accident occurs while the
coverage on an insured person
is effective under the policy
– the insured person’s engaging in an illegal activity or occupation
– the insured person’s voluntary participation in any riot or
civil insurrection
– declared or undeclared war, or any act of declared or
undeclared war
–the insured person’s operating, learning to operate, serving
as a crew member of, or jumping, parachuting, or falling from
an aircraft or hot air balloon, including those which are not
motor driven
–the insured person’s engaging in hang gliding, sailgliding,
bungee jumping, parachuting, parasailing or parakiting or any
similar activity
– the insured person’s riding in or driving any motor driven vehicle
in a race, stunt show or speed test
–the insured person’s practicing for or participating in any
semiprofessional or professional competitive athletic contest
for which such insured person receives any compensation
or remuneration
– the insured person’s operating any type of land, water or air
vehicle while having a blood alcohol content at or above the
level made illegal for operation of such vehicle by the jurisdiction
where the accidental injury occurred
– any illness, loss or condition specifically excluded from the
definition of any accident
10 EXCLUSIONS
■■ The accident is treated within
the United States
■■ The benefit payment is not
precluded by any general
or specific exclusion,
description, or any failure to
meet any condition precedent
stated in the policy
The company reserves the right
to request that a physician of
the company’s choice review
any diagnosis in the event of
a dispute or disagreement
regarding the appropriateness
or correctness of a diagnosis.
The company also reserves
the right to require that an
insured person submit to
an examination to confirm a
disputed injury. The company
reserves the right to request
that an independent and
acknowledged expert in the
applicable field of medicine
review the evidence used in
making any disputed diagnosis.
The company will pay for any
such requested examination
or review.
Underwriting
The underwriting basis for the EmergencyCare Plus base policy will be simplified issue based on five
knock-out questions and will require an accident application only. There will not be a medical information
bureau (MIB) check.
Underwriting Rules for Accident-only Disability Income Benefit RIder
OccupationalClassifications
The following occupational class descriptions and examples provide a guideline for determining Disability
Income Rider rate classes. Examples are not meant to serve as an all inclusive list of occupations.
Class 1. Professional and
White Collar Occupations
Class 2. Gray and
Blue Collar Occupations
Professionals would include
individuals in very responsible
positions and typically holding
advanced degrees and
professional designations or be
an officer of a large corporation.
Examples: architects, engineers,
CPAs and corporate officers.
Gray Collar would include
positions that may be either
salaried or hourly paid; they
will generally be recognized as
skilled workers some of whom
will have supervisory duties.
Typically a college degree is
not required and the skills are
usually learned on the job.
Examples: office clerical,
technicians, receptionists,
registered nurses and
physical therapists.
White Collar would include
individuals who are generally
salaried employees, possess
special technical skills, are well
educated and frequently have
managerial responsibilities. Their
positions do not expose them to
on-the-job risks of physical injury
or environmental hazards.
Examples: lawyers, physicians,
dentists, pharmacists, teachers,
administrators, research analysts.
Blue Collar would include jobs
that are usually paid on an hourly
basis; many require relatively
limited skills and modest formal
education. In many cases the
physical demands are high and
the tasks frequently require
manual labor. It is not uncommon
for there to be some exposure to
accidental injury and/or adverse
working conditions.
Examples: construction trades,
mechanics, machine operators,
assemblers, LPNs, nurse aides.
Unacceptable Risks
These jobs are usually
characterized by six categories
of exposure:
1. There is a high risk of
accidental injury. Examples:
logging, subsurface mining,
construction, law enforcement,
firefighting, explosives,
military service.
2.The work may be very
physically demanding.
Examples: farm laborers,
household movers,
professional athletes.
3.There is a very high degree
of mental stress. Examples:
air traffic controllers.
4.There may be exposure to
an adverse and/or dangerous
working environment.
Examples: hazardous materials
handlers; high elevations;
exposure to heat, cold or
airborne particulate matter.
5.The jobs demand that a very
high standard of physical
fitness be maintained.
Examples: pilots, common
carriers, police, firefighters,
professional athletes.
6.The skills required are
such that a minor injury or
impairment may be disabling.
Examples: entertainers,
musicians, professional
athletes.
POLICY FEATURES 11
Family Coverage
Insured Spouse
If the words “Insured Spouse” are not shown as an “Insured
Person” in the policy data, this provision does not apply and the
company will pay no benefits for a spouse.
Coverage on an insured spouse will terminate on the policy
anniversary on or following the insured spouse’s 75th birthday.
The termination of coverage on the insured spouse will not reduce
our liability for any claim originating prior to the termination of
such coverage.
If the policy is in force and the insured dies, the insured spouse may
continue the policy by payment of the required premiums when
they are due. The following conditions will apply:
■■ the insured spouse will become the insured under the policy; and
■■ the premiums will be based on the insured spouse’s age on the
date of issue of the policy.
If the policy is in force and the insured spouse dies, the company
will reduce the premium.
If the policy is in force and the insured’s marriage to the insured
spouse is terminated by a divorce decree, the insured spouse may
obtain a separate accident policy, subject to the conversion privilege
provision described on page 9. Coverage provided on any insured
person by the policy cannot be continued if the insured person is
subsequently covered by a separate accident policy issued by the
company. Coverage on any insured person provided by the policy
ceases when coverage on such insured person becomes effective
under a separate accident policy issued by the company.
Insured Children
If the words “Insured Child” are not shown as an “Insured Person”
in the policy data, this provision does not apply and the company
will pay no benefits for the insured’s child.
An “Insured Child” under the policy means the insured’s biological
or legally adopted child who is unmarried and dependent on the
insured, and is:
■■ named in the application and is less than 19 years of age on the
date of application;
■■ born after the effective date of the policy, and the insured is
named as parent on the child’s birth certificate; or
■■ legally adopted by the insured after the effective date of the policy
and before the child’s 19th birthday.
12 FAMILY COVERAGE
Family Coverage
(continued)
Coverage on any insured child will terminate on the earlier of:
■■ the date on which the policy lapses or terminates for the failure to
meet a condition precedent required in the policy;
■■ the premium due date following the insured child’s 19th birthday
unless:
– the insured child remains dependent on the insured; and
– the insured child is either enrolled as a full-time student in high
school or in an institution of higher learning beyond high school,
or has been so enrolled for at least five months of each year
since his or her 19th birthday, or is eligible to enroll in such an
institution but is prevented from enrolling due to illness or injury;
– the premium due date after the insured child’s 25th birthday if
coverage on an insured person is continued past the insured
child’s 19th birthday under this provision; or
– the date of issue of a separate policy, which is issued to the
insured spouse and provides coverage on the insured child
The termination of an insured child’s coverage will not reduce the
company’s liability for any claim originating prior to the termination.
If the policy is in force when an insured child’s coverage terminates,
such insured child may obtain a separate accident policy, subject to
the conversion privilege provision described on page 9.
The coverage provided on an insured child by the policy may be
continued, so long as the insured child is:
■■ legally incapable of self-sustained employment due to mental or
physical incapacity; or
■■ dependent upon the insured for support and maintenance.
The insured must submit satisfactory proof of incapacity or
dependency to the company within 31 days of the date on which
the coverage on the insured child would terminate if he or she were
not incapacitated or dependent, and subsequently as the company
may require, but not more frequently than annually after the twoyear period following the date of coverage on the insured child
would otherwise have terminated. The company may charge an
additional premium for continuing the coverage on any insured child.
The company will determine the premium on the basis of the age,
sex, and premium rate and class in effect for the insured child on
the date of proof of incapacity or dependency is provided.
Note: The premium will be recalculated to reflect the current
covered insureds at their original issue age. An individual and
child(ren) policy can be changed to individual policies on all covered
children without evidence of insurability at their current attained age.
The accident policy available to children will be the current actively
marketed accident policy being sold by American General Life at the
time of conversion.
FAMILY COVERAGE 13
Premiums
Premium rates current as of February 2010; rates may vary by state.
EmergencyCare Plus Insurance (Base Policy)
Annual premium per unit; 1 to 4 units available
Coverage Tier
Nationwide
Florida
New
Hampshire
Minnesota
Individual
$74.16
$80.75
$72.11
$75.36
Individual & Spouse
106.52
114.31
103.45
107.32
Parent & Children
112.16
122.11
108.99
113.56
Family
151.51
163.33
147.25
152.51
Accidental Death and Dismemberment Rider
Annual premium per unit; 1 to 6 units available
Coverage Tier
Nationwide
Florida
New
Hampshire
$21.25
$24.25
$24.23
Individual & Spouse
31.88
36.38
36.38
Parent & Children
23.88
26.68
26.35
Family
34.00
38.80
38.80
Individual
If this rider is selected, all dependents covered by the base policy
will be covered by the rider.
Hospital Cash Rider
Annual premium per unit; 1 to 5 units available
Coverage Tier
Nationwide
Florida
$16.76
$18.25
Individual & Spouse
29.42
33.45
Parent & Children
31.25
34.02
Family
42.96
48.19
Individual
If this rider is selected, all dependents covered by the base policy
will be covered by the rider.
14 PREMIUMS
Premiums
(continued)
Accident-only Disability Income Benefit Rider
Annual premium per unit; 4 to 10 units available (7-day elimination period; off-the-job coverage is not
available in Pennsylvania)
Benefit Period
6 Months
12 Months
Occupation Class
1
2
1
2
Elimination Period
7 days
7 days
7 days
7 days
Nationwide Off-the-Job Coverage
$6.85
$11.60
$8.95
$14.20
Nationwide 24-Hour Coverage
16.85
33.70
21.60
41.60
7.81
13.22
10.20
16.19
19.21
38.42
24.62
47.42
7.80
13.20
10.20
16.20
19.20
38.40
24.60
47.40
Florida Off-the-Job Coverage
Florida 24-Hour Coverage
New Hampshire Off-the-Job Coverage
New Hampshire 24-Hour Coverage
Modal Factors:
Modal Formulas:
Policy Fee Breakdown:
A = Annual
S = Semiannual
Q = Quarterly
ABD= Monthly
Automatic Bank Draft
PD = Monthly Payroll
Deduction
The formulas for computing
modal factors are given below.
Annual payments: No policy fee
Semiannual payments:
2 payments x $0.40 = $0.80 in
policy fees collected annually
Quarterly payments:
4 payments x $0.40 = $1.60 in
policy fees collected annually
Monthly payments:
12 payments x $0.40 = $4.80 in
policy fees collected annually
Nationwide (all approved states
except Florida):
S = A x 0.52 + 0.40
Q = A x 0.265 + 0.40
ABD = A x 0.095 + 0.40
PD = A x 0.095 + 0.40
Florida only:
S = A x 0.50 + 0.40
Q = A x 0.25 + 0.40
ABD = A x 0.0833 + 0.40
PD = A x 0.0833 + 0.40
Policy fees: $0.40 per premium
collected except on an annual
basis. The policy fee is not
applied to the annual mode.
Premium structure: The
premium will be calculated for
each of the coverage tiers. There
will not be a separate premium
for the primary insured, spouse
and children.
Coverage tiers: Individual
(employee), Individual and
Spouse, Individual and
Child(ren), and Family
PREMIUMS 15
Premiums
(continued)
EmergencyCare Plus Insurance Package Plan Rates
For your convenience we have created the Gold, Silver and Bronze package plans that contain the most
popular combination of benefits.
ANNUAL PACKAGE RATES
Includes Base Policy and Hospital Cash Rider
National
Florida
New Hampshire
Minnesota
Gold Plan = 3 Units Base Policy, 5 Units Hospital Cash Rider
Individual
$306.28
$333.50
$300.13
$309.88
Individual & Spouse
466.66
510.18
457.45
469.06
Parent & Child
492.73
536.43
483.22
496.93
Family
669.33
730.94
656.55
672.33
Silver Plan = 2 Units Base Policy, 5 Units Hospital Cash Rider
Individual
$232.12
$252.75
$228.02
$234.52
Individual & Spouse
360.14
395.87
354.00
361.74
Parent & Child
380.57
414.32
374.23
383.37
Family
517.82
567.61
509.30
519.82
Bronze Plan = 1 Unit Base Policy, 5 Units Hospital Cash Rider
Individual
$157.96
$172.00
$155.91
$159.16
Individual & Spouse
253.62
281.56
250.55
254.42
Parent & Child
268.41
292.21
265.24
269.81
Family
366.31
404.28
362.05
367.31
OPTIONAl Accident-Only Disability Income Benefit Rider
(7-Day elimination, off-the-job coverage is not available in Pennsylvania)
National
Off-the-Job
Florida
24-Hour
Off-the-Job
New Hampshire
24-Hour
Off-the-Job
24-Hour
$600 per Month Benefit
6 Months - Class 1
$41.10
$101.10
$46.86
$115.26
$46.80
$115.20
- Class 2
69.60
202.20
79.32
230.52
79.20
230.40
12 Months - Class 1
53.70
129.60
61.20
147.72
61.20
147.60
- Class 2
85.20
249.60
97.14
284.52
97.20
284.40
6 Months - Class 1
68.50
168.50
78.10
192.10
78.00
192.00
- Class 2
116.00
337.00
132.20
384.20
132.00
384.00
12 Months - Class 1
89.50
216.00
102.00
246.20
102.00
246.00
- Class 2
142.00
416.00
161.90
474.20
162.00
474.00
$1000 per Month Benefit
16 PREMIUMS
Premiums
(continued)
EmergencyCare Plus Insurance Package Plan Benefits
Benefit
Gold Plan
Silver Plan
Bronze Plan
Accidental Death
Primary: $75,000
Spouse: $15,000
Child(ren): $3,000
Primary: $50,000
Spouse: $10,000
Child(ren): $2,000
Primary: $25,000
Spouse: $5,000
Child(ren): $1,000
Dismemberment
Primary: up to $45,000
Spouse: up to $22,500
Child(ren): up to $7,500
Primary: up to $30,000
Spouse: up to $15,000
Child(ren): up to $5,000
Primary: up to $15,000
Spouse: up to $7,500
Child(ren): up to $2,500
Emergency Treatment
$150
$100
$50
Accident Follow-Up
$45 per treatment
3 per accident
$30 per treatment
3 per accident
$15 per treatment
3 per accident
Ambulance
Ground: $225, Air: $1,500
Ground: $150, Air: $1,000
Ground: $75, Air: $500
Burns (30% or more of the body)
Up to $7,500
Up to $5,000
Up to $2,500
Up to $5,100
Up to $1,350
Up to $3,400
Up to $900
Up to $1,700
Up to $450
$150 per day (30 days max)
$100 per day (30 days max)
$50 per day (30 days max)
Up to $6,000
Up to $3,000
Up to $4,000
Up to $2,000
Up to $2,000
Up to $1,000
Lacerations
$150
$100
$50
Diagnostic Exams
$225
$150
$75
Paralysis
Quadriplegia: $7,500
Hemiplegia: $4,500
Paraplegia: $3,000
Quadriplegia: $5,000
Hemiplegia: $3,000
Paraplegia: $2,000
Quadriplegia: $2,500
Hemiplegia: $1,500
Paraplegia: $1,000
Physical Therapy
$30 per treatment (10 max)
$20 per treatment (10 max)
$10 per treatment (10 max)
Prosthesis
$750
$500
$250
Surgery
Up to $1,200
Up to $800
Up to $400
Transportation
$450 round trip
$300 round trip
$150 round trip
Dislocation
Open Reduction:
Closed Reduction:
Family Lodging
Fracture
Open/Compound:
Closed:
Hospital Cash Benefit = 5 units
Hospital Admission
$1,750 per admission
Hospital Confinement
$375 per day
30 days per confinement, 365 days lifetime limit
Intensive Care Unit
$375 per day
15 days per injury
Rehabilitation Unit
$100 per day
30 days per injury, up to 60 days per year
PREMIUMS 17
Application Process
Where to Find Forms
American General Life hosts forms in an application called
Forms Depot accessed via our producer Website eStation
(http://eStation.aglife.com). If you have questions or cannot find
what you need, call 1-877-399-7747 for assistance.
EmergencyCare Plus Forms
In an effort simplify the application process, we have created
Application Packs by state in Forms Depot that contain all the forms
you need to submit for most cases. The forms included in the
application pack are listed below.
Applications Packs
■■ EmergencyCare Plus Application (varies by state)
■■ EmergencyCare Plus Outline of Coverage (varies by state)
■■ Supplemental Application — Included in the Application Pack for
Colorado and South Carolina only.
■■ Non-Occupational Endorsement — To be used if coverage is
restricted to accidents that occur outside of the policyholder’s
regular occupation. This typically occurs when the policyholder
engages in a high-risk occupation such as law enforcement or
firefighting.
■■ Privacy Notice — Agent must provide to applicant for informational
purposes. The Privacy Notice is used with all American General Life
Accident and Health products.
■■ Electronic Funds Transfer — If your client will use EFT to pay initial
premium and future payments, you must complete and submit this
form with the client’s cancelled check.
Other Forms and When to Use
■■ Policy Delivery Receipt — This form is required in Louisiana,
Pennsylvania, South Dakota, and West Virginia. We recommend
completing this form for all other states.
■■ Credit Card Authorization — If your client would like to make
the initial premium payment with a credit card, you will need to
complete this form.
18 APPLICATION PROCESS
Completing the
application for
package plans:
X
If your client chooses the Gold, Silver or Bronze plan, you will
need to indicate that choice in section 12 of the Application for
Accident Insurance by writing in – Gold, Silver or Bronze after
the word “units”. Then select Primary Insured, Primary Insured
& Spouse, or Primary Insured & Children. There is no need
to select the Hospital Cash Rider as the maximum benefit is
included in the Gold, Silver and Bronze package. Also remember
that the base policy of the Gold, Silver and Bronze plans include
Accidental Death and Dismemberment (AD&D) benefits (Gold
- 3 units, Silver – 2 units, Bronze – 1 unit). Therefore, select the
AD&D Rider ONLY if your client wants more units of AD&D than
what is included in the base Gold, Silver or Bronze plan.
Do not select for package plans u
Select only if client wants more than units included in plan u
(Gold=3, Silver=2, Bronze=1)
X
Gold
APPLICATION PROCESS 19
Glossary of Terms
■■ Accident means the
unforeseen occurrence of
an event, which results
in accidental injury to an
insured person wholly
independent of disease,
bodily infirmity, illness,
infection or any other
physical condition
■■ A
ccidental Injury means
bodily injury to an insured
person as the result of an
accident, after coverage
under the policy takes effect
and while the policy is in
force, which results:
– in a loss of life or
dismemberment within 90
days after the date injury is
sustained; or
– in emergency medical
treatment; in follow-up
treatment; in treatment for
severe burns, dislocation
or laceration; or in surgery
within 72 hours after the
injury is sustained
■■ A
ge means the attained age
as of the insured person’s
last birthday
■■ A
mbulance means a
specially equipped vehicle,
licensed and used to
transport the sick or injured
■■ B
enefit means covered
conditions listed on page 5
and in the policy schedule
■■ C
losed Fracture means a
fracture in which the bone is
not protruding through the skin
■■ C
losed Reduction means
a manipulative repair of a
fracture or dislocation
20 DEFINITIONS
■■ C
ommon Carrier means
a taxicab, streetcar, bus,
train, boat, airplane or
other vehicle, which is
duly licensed by a proper
authority to transport
passengers for a fee
■■ D
iagnosis/Diagnosed
means a definitive diagnosis
made by a physician,
licensed and practicing
in the United States and
its territories and, where
applicable, specializing in a
particular field of medicine,
which:
– is based upon the use of
diagnostic evaluations,
clinical and/or laboratory
investigations, tests
and observations, and
where the results are
documented in and
supported by the insured
person’s medical records;
and
– meets all diagnostic
requirements stated in the
policy for the particular
accident being diagnosed
■■ D
islocation means the
displacement of a body part,
especially the temporary
displacement of a bone
from its normal position
that is diagnosed by a
physician within 72 hours
after an accidental injury.
The dislocation must require
correction by a physician
using open or closed
reduction.
■■ D
ismemberment means the
accidental loss of limb or sight:
– arm, actual severance
above the elbow;
– leg, actual severance
above the knee;
– hand, actual severance
above the wrist;
– foot, actual severance
above the ankle;
– finger, actual severance at the
joint (proximate to the first
interphalangeal joint) where
it is attached to the hand;
– toe, actual severance at
the joint (proximate to the
first interphalangeal joint)
where it is attached to the
foot; or
– eye, loss of the eye or
permanent vision loss
such that central vision
acuity cannot be corrected
to better than 20/200
Loss of use does not constitute dismemberment, except
as stated in “eye” above.
■■ E
mergency Room means
a specified area within a
hospital that is designated
for the emergency care
of accidental injuries. This
area must:
– be staffed and equipped to
handle trauma;
– be supervised and provide
treatment by a physician(s);
and
– provide care seven days per
week, 24 hours per day.
■■ F
racture means a break,
rupture or crack in a bone
that can be diagnosed by
X-ray. The fracture
must be diagnosed by
a physician within 14
days after the date of the
accidental injury and must
require correction by a
physician through either
open or closed reduction.
Glossary of Terms
(continued)
■■ Full-Thickness or ThirdDegree Burn means the
injury and destruction of skin
through the entire thickness
or depth of the dermis, and
possibly to underlying tissue,
with a loss of fluid, and
sometimes shock, caused
by exposure to fire, heat,
caustics, electricity or radiation
■■ Hemiplegia means the
complete and irreversible
paralysis of the upper and
lower limbs of the same side
of the body
■■ Hospital means an institution:
– operated pursuant to
law and is licensed as a
hospital by the responsible
state agency;
– primarily and continuously
engaged in providing or
operating, either on its
premises or in facilities
available to the hospital
on a prearranged basis
and under the supervision
of a staff of duly licensed
physicians, medical,
diagnostic and major
surgical facilities for
the medical care and
treatment of sick or injured
persons on an inpatient
basis for which a charge is
made; and
– that provides 24-hour
nursing service by or
under the supervision
of registered graduate
professional nurses (RNs)
Hospital does not mean or
include:
– convalescent, assisted
living, extended care,
hospice, rest or nursing
facilities; or
– facilities primarily affording
custodial, educational or
rehabilitative care; or facilities
primarily for the aged or
for substance abusers
■■ Hospital Confinement
means an insured person
confined to a bed in a
hospital for which a room
charge is made. The hospital
confinement must be on the
advice of a physician and
medically necessary as a
result of injuries sustained
in a covered accident or for
rehabilitory care for injuries
sustained in a covered
accident.
■■ Immediate Family Member
means a person who is related
to the insured person in any of
the following ways: spouse;
child (including a legally
adopted child, stepchild, sonin-law and daughter-in-law);
parent (including stepparent,
mother-in-law and father-inlaw); and brother or sister
(including stepbrother,
stepsister, brother-in-law and
sister-in-law)
■■ Injury/Injuries means bodily
injury sustained by an insured
person as a direct result of
an accident, after coverage
under the policy takes
effect and while the policy
is in force, independent of
disease, bodily infirmity,
illness, infection or any other
physical condition
■■ Insured means the person
named as “Insured” in the
policy data on page 1 of the
policy form (or to the insured
spouse, if one is indicated
as an “Insured Person” in
the policy data and such
insured spouse becomes the
“Insured” upon the death
of the person named as
“Insured” in the policy data)
■■ Insured Person means all
persons who are indicated as
an “Insured Person” in the
policy data on page 1 of the
policy form as being covered
by the policy
■■ Laceration means a cut
requiring at least two stitches by
a licensed medical professional
■■ Limb means the entire arm
or entire leg
■■ Month means a calendar
month
■■ Open Fracture means a
fracture in which the bone
is protruding through the
skin. An open fracture is also
referred to as a compound
fracture.
■■ Open Reduction means the
surgical repair of a fracture or
dislocation
■■ Paralysis/Paralyzed means
spinal cord injuries sustained
in an accident that results in
the loss of use of 2 or more
limbs and must last for a
minimum of 30 days and is
expected to be permanent.
Paralysis must be confirmed
by the insured person’s
attending physician.
■■ Paraplegia means the
complete and irreversible
paralysis of both lower limbs
DEFINITIONS 21
Glossary of Terms
(continued)
■■ Physician means a person
who:
– is a legally qualified
practitioner of the healing
arts and is licensed in the
United States or
its territories;
– practices within the scope
of his or her license;
– is not the insured person;
– is not related to the
insured person as a
spouse, parent, child or
sibling; and
– does not customarily reside
in the same household as
the insured person
■■ Physical Therapy means a
branch of rehabilitative health
care that uses specially
designed exercises
and equipment to help
patients regain or improve
their physical abilities
■■ Principal Sum means the
number of units, shown in
the policy data on page 3 of
the policy form, multiplied
by the applicable benefit
amount per unit shown in
the policy schedule benefits
amounts on page 3A of the
policy form
■■ Prosthetic Device means a
removable artificial substitute
or replacement of a part of
the body. “Prosthetic Device”
does not mean or include:
– dental aids, including
false teeth;
– eye glasses;
– cosmetic prosthesis such
as hair wigs;
– other types of prosthetic
devices that are permanently
implanted, such as an
artificial hip or tooth;
– any experimental
prostheses; or
– auditory prosthesis (a device
that substitutes for or
enhances the ability to hear).
■■ Quadriplegia means the
complete and irreversible
paralysis of both upper and
lower limbs
■■ School Bus means a bus,
owned or leased by a public
school system or a private
school, which is being
operated during the regular
session of a recognized
public or private school for
the transportation of students
to or from school, or to or
from any organized school
extracurricular activity
■■ Severe Burn means the
cosmetic disfigurement of
body surface or area that is a
full-thickness or third-degree
burn covering at least 10% of
the body surface
22 DEFINITIONS
■■ Surgery means a surgical
operation or procedure,
especially one involving the
repair or removal of an organ
or tissue due to an accidental
injury
■■ Unit means the single
quantity of coverage shown
in the policy data on page 3
of the policy form
■■ United States means the
50 states, plus the District
of Columbia, and includes
Guam, the U.S. Virgin Islands
and Puerto Rico
■■ Year means a consecutive
365-day period
Policies issued by:
American General Life Insurance Company
2727-A Allen Parkway, Houston, Texas 77019
EmergencyCare Plus Policy Form Number 04120
Accidental Death and Dismemberment Rider Form Number 04022
Accident-Only Disability Income Benefit Rider Form Number 04023 and 04024
Hospital Cash Rider Form Number 04025
The underwriting risks, financial and contractual obligations and support functions associated with products
issued by American General Life Insurance Company (AGL) are its responsibility. AGL does not solicit business
in the state of New York. Policies and riders not available in all states.
These product specifications are not intended to be all-inclusive of product information. State variations may
apply. Please refer to the policy and rider for complete details.
American General Life Companies, www.americangeneral.com, is the marketing name for the insurance
companies and affiliates comprising the domestic life operations of American International Group, Inc.,
including AGL.
American General Life Companies offer a broad spectrum of fixed and variable life insurance, annuities and
accident and health products to serve the financial and estate planning needs of its customers throughout the
United States.
Important : All benefits payable are subject to the terms and conditions of the policy, including benefit
durations, limitations and exclusions. Not all benefits and exclusions apply in every state. Please consult the
policy form and outline of coverage for details. There may be a charge for each rider selected. See the rider for
details regarding the benefit descriptions, limitations and exclusions. Comprehensive medical coverage may be
required in some states in order to apply for or maintain the policy.
Prior to soliciting business, be certain that you are appropriately licensed and appointed with the insurer and
that the product has been approved for sale by the insurer in that state. If uncertain, contact your American
General representative for assistance.
FOR AGENT USE ONLY-NOT FOR DISSEMINATION TO THE PUBLIC
© 2010. All rights reserved.
AGLC101637 REV0210